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Home My WebLink About0271 OCEAN STREET - Health 271 OCEAN S HYANNIS �) EWFR A = 325 024 i ICI I No. ---- Fee----- -- --------- BOARD OF HEALTH TOWN OF BARNSTABLE v/ Application-for lVell Con5truct ion Permit Application is hereby made for �te permit to Construct (/), ), or R aair ( )an indiv ual Well at: I.oca ion — Address Assessors Map and cel Owner Address ----------- Installer — Driller Ad ress Type of Building Dwelling _-- — -- - —---------- Other - Type of Building—= --____—_—_--- No. of Persons--------------------------- T e of Well��1 ! .� ,V -------- Capacity Purpose of Well---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed6e,, Application Approved By -------- --_- date Application Disapproved for the following reasons: --------------------- --_ - — --- ----------------- date Permit No. G — -- Issued---- G _ --o ---- ------------ �� date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) by--___ ^ � ��rr5l ——--- ----- — -- - --___----------------- Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well P otection Regulation as described in the application for Well Construction Permit No.�0��=3 —Dated—�� -THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—- Inspector--------------- ---------- No.�✓-"-0 Fee-----�---- ------ -- BOARD OF HEALTH t TOWN OF` BARNSTABLE x'. ZIppluat ion-*rVell Con5tructionprrmit Application is hereby made for a permit to Construct (/), Alter ), or Repair ( )an indivi ual Well at: , Z J 0 2 Loc lion - Address Assessors Map and cel --- of — _ �--..._ _- - -- ----- __' ^� Own Address - ?W--- � Installer Dnller _.' Address - Type of Building Dwelling --_-- --- - -- — Other Type of Building------ -----_ No. of Persons—------------__---_-____ Type of Well �� Ca acit Purpose of Well Agreement: $: The'undersigned agrees to install the aforedescribed individual well.in.accordance With the provisions of The ' I Town'of:Barnstable.Board sof,Health"Private Well.Protection Regulation.,- Th.e.undersigned further agrees not to place,the.well,,in,operation,until aCertificate .of Compliance.has been issued by-the Board of Health. - Signed- - ate ry Application Approved BYe7�— date Application Disapproved for the following reasons: .'.n. -- - --------------- —�------�,---------date Permit No.-- Li 6 _3 Z_ — Issued �-date -- BOARD OF HEALTH i TOWN OF BARNSTABLE Certificate Of Compliance iTHIS IS TO,CERTIFY That the Individual Well Constructed (i ), Altered ( ), or Repaired Installer. -- has been installed in accordance with the provisions of the Town,of Barnstable Board of Health Private Well Protection Regulations as;described m the application'for Well Construction Permit No. = -_Dated=G /o,/---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--__ - -- Inspector—__--- — --_----------—-- HEALTH TOWN OF BARNSTABLE Vell ConMruct ion Permit No. &J O —3 Fee x Permission is hereby,,granted ----- to Construct'(. ); Alter'(:. ); or Repair ( ) an Individual Well'at: i No _ � N S- f- `DrZ�o/ -- = L✓�1�iit!__ - - - as shown on the application for a Well Construction Permit pNo.- - Dated--7- ___— -------------_------------------- - a: / Board of Health DATE -64 /Zo ASSESSORS MAP No. PARCRNO;. 9 Fee-- BOARD OF HEAL TOWN OF BARNSTABLE Zipp[ication for lVell Con5tructionPermit Application is hereby made f r a e it to Construct Alter or individual Well a p y p p Fu ( ( ), Repair ( )an Inds a t. — - - --- Location — Address Assessors Map and Parcel caner -- � O,wneJr �^' Address �f ----- �d ___-- --—-- -- 4!!' dY1 G� �--SQo_ oS�l_L�' Installer Driller Address Type of Building Dwelling ----- ---- ----- Other - Type of Building------ ---- No. of Persons--------___—__—_—_______ Type of Well Capacity--- — -' -- --- Purpose of Well---- ------ — — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a ,Certificate .of Compliance has been issued by the Board of Health. Signed — d to Application Approved — ------ --- v � r date Application Disapproved for the following reasons: --------------------_--_______—__—___—________ date Permit No. � � ---- Issued--- j. v cf ------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS jQ C-ERRTIFY, That the Ii dividual Well Constructed (l/f, Altered ( ), or Repaired ( ) by— �/ __— — ---- - ----- — -- - ------ —_------ Installer at--- � d c5yce.-9.9 s7C --------has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Wej_Protection Regulation as described in the application for Well Construction Permit ! - ate ---------_----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- - — Inspector-- ----- - - --- ------—-- No. a �1a� � /ems Fee--�� -- BOARD OF HEAL `I . TOWN OF BARNSTABLE . Application ApplicationArVell Con5truct ion Permit Application is hereby made f r a pe it to Construct (Z-r,'Alter ( ), or Repair ( )an individual Well at: Location —a Address Assessors.Map and Parcel 'Owner—� — Address --------- -------- Installer — Driller Address _ Type of Building Dwelling ----- -- - --- --- Other - Type of Building - No. of Persons-------------________! f Type of Well f�—G ---- ------ Capacity -�`=---- ------------------- Purpose of Well---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private'Well,Protection Regulation — The undersigned further agrees not to place the well in operation until.aCertificate of Compliance has been issued by the Board of Health. Signed ,_ _`✓� — — — _— = o/_^_ date Application Approved date Application Disapproved for the following reasons: --- ---- -----------------— ------------ - — -- ------------------------------------------------ date Permit No. e- � - — Issued—�— � � � � date BOARD OF HEALTH TOWN OF BARNSTABLE r r Certificate & Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (6,, Altered ( ), or Repaired ( ) by Installer at --- has been installed in accordance with the provisions of the Town of Barnstable Board oof Health P�rivate Well Protection Regulation as described in the application for Well Construction Permit THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector----------------------- ------ BOARD OF HEALTH TOWN OF BARNSTABLE lVell Construct ion hermit NO. ` * � Fee =-- \ , Permission is herebygranted : --- ----------------------------- to Construct Cam), Alter ( ), or Repair ( ) an Individual Well at: Street as shown on the application for a Well Construction Permit No.- Dated--- -------- Board of Health DATE f .